Wireless patient monitoring system

ABSTRACT

A device for obtaining physiological information of a medical patient can include a blood pressure device that can be coupled to a medical patient and a wireless transceiver electrically coupled with the blood pressure device. The wireless transceiver can wirelessly transmit blood pressure data received by the blood pressure device and physiological data received from one or more physiological sensors coupled to the blood pressure device.

RELATED APPLICATIONS

This application claims priority benefit under 35 U.S.C. §120 to and isa continuation-in-part of U.S. patent application Ser. No. 12/840,209,filed Jul. 20, 2010, entitled “Wireless Patient Monitoring System,”which claims the benefit of priority under 35 U.S.C. §119(e) of thefollowing U.S. Provisional Patent Applications:

App. No. Filing Date Title Attorney Docket 61/226,996 Jul. 20, 2009Wireless Blood MASIMO.730PR Pressure Monitoring System 61/259,037 Nov.6, 2009 Wireless Blood MASIMO.730PR2 Pressure Monitoring System61/290,436 Dec. 28, 2009 Acoustic MASIMO.763PR2 Respiratory Monitor61/350,673 Jun. 2, 2010 Opticoustic Sensor MASIMO-P120

Each of the foregoing applications is incorporated by reference in theirentirety.

BACKGROUND

Hospitals, nursing homes, and other patient care facilities typicallyinclude patient monitoring devices at one or more bedsides in thefacility. Patient monitoring devices generally include sensors,processing equipment, and displays for obtaining and analyzing a medicalpatient's physiological parameters such as blood oxygen saturationlevel, respiratory rate, and the like. Clinicians, including doctors,nurses, and other medical personnel, use the physiological parametersobtained from patient monitors to diagnose illnesses and to prescribetreatments. Clinicians also use the physiological parameters to monitorpatients during various clinical situations to determine whether toincrease the level of medical care given to patients.

Blood pressure is one example of a physiological parameter that can bemonitored. Many devices allow blood pressure to be measured bysphygmomanometer systems that utilize an inflatable cuff applied to aperson's arm. The cuff is inflated to a pressure level high enough toocclude a major artery. When air is slowly released from the cuff, bloodpressure can be estimated by detecting “Korotkoff” sounds using astethoscope or other detection means placed over the artery.

SUMMARY

In certain embodiments, a device for obtaining physiological informationof a medical patient can include a blood pressure device that can becoupled to a medical patient and a wireless transceiver electricallycoupled with the blood pressure device. The wireless transceiver canwirelessly transmit blood pressure data received by the blood pressuredevice and physiological data received from one or more physiologicalsensors coupled to the blood pressure device. To further increasepatient mobility, in some embodiments, a single cable is also providedfor connecting multiple different types of sensors together.

For purposes of summarizing the disclosure, certain aspects, advantagesand novel features of the inventions have been described herein. It isto be understood that not necessarily all such advantages can beachieved in accordance with any particular embodiment of the inventionsdisclosed herein. Thus, the inventions disclosed herein can be embodiedor carried out in a manner that achieves or optimizes one advantage orgroup of advantages as taught herein without necessarily achieving otheradvantages as can be taught or suggested herein.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments will be described hereinafter with reference to theaccompanying drawings. These embodiments are illustrated and describedby example only, and are not intended to limit the scope of thedisclosure. In the drawings, similar elements have similar referencenumerals.

FIGS. 1A and 1B illustrate embodiments of wireless patient monitoringsystems;

FIGS. 2A and 2B illustrate embodiments of wireless patient monitoringsystems having a single cable connection system;

FIGS. 3A and 3B illustrates additional embodiment of patient monitoringsystems;

FIGS. 4A and 4B illustrate embodiments of an optical ear sensor and anacoustic sensor connected via a single cable connection system;

FIG. 5 illustrates an embodiment of a wireless transceiver that can beused with any of the patient monitoring systems described above;

FIGS. 6A through 6C illustrate additional embodiments of patientmonitoring systems; and

FIG. 7 illustrates an embodiment of a physiological parameter displaythat can be used with any of the patient monitoring systems describedabove.

FIG. 8 illustrates a further embodiment of a patient monitoring system.

DETAILED DESCRIPTION

In clinical settings, medical sensors are often attached to patients tomonitor physiological parameters of the patients. Some examples ofmedical sensors include blood oxygen sensors, blood pressure sensors,and acoustic respiratory sensors. Typically, each sensor attached to apatient is connected to a bedside monitoring device with a cable. Themore cables that couple the patient to the bedside monitoring device,the more the patient's freedom of movement can be restricted. Inaddition, cables pose a tripping hazard to health care workers and makeit difficult to perform rapid transport to therapeutic areas such as theoperating room when emergency situations arise.

This disclosure describes embodiments of wireless patient monitoringsystems that include a wireless device coupled to a patient and to oneor more sensors. In one embodiment, the wireless device transmits sensordata obtained from the sensors to a patient monitor. By transmitting thesensor data wirelessly, these patient monitoring systems canadvantageously replace some or all cables that connect patients tobedside monitoring devices. To further increase patient mobility andcomfort, in some embodiments, a single cable connection system is alsoprovided for connecting multiple different types of sensors together.

These patient monitoring systems are primarily described in the contextof an example blood pressure cuff that includes a wireless transceiver.The blood pressure cuff and/or wireless transceiver can also be coupledto additional sensors, such as optical sensors, acoustic sensors, and/orelectrocardiograph sensors. The wireless transceiver can transmit bloodpressure data and sensor data from the other sensors to a wirelessreceiver, which can be a patient monitor. These and other featuresdescribed herein can be applied to a variety of sensor configurations,including configurations that do not include a blood pressure cuff.

FIGS. 1A and 1B illustrate embodiments of wireless patient monitoringsystems 100A, 100B, respectively. In the wireless patient monitoringsystems 100 shown, a blood pressure device 110 is connected to a patient101. The blood pressure device 110 includes a wireless transceiver 116,which can transmit sensor data obtained from the patient 101 to awireless transreceiver 120. Thus, the patient 101 is advantageously notphysically coupled to a bedside monitor in the depicted embodiment andcan therefore have greater freedom of movement.

Referring to FIG. 1A, the blood pressure device 110 a includes aninflatable cuff 112, which can be an oscilometric cuff that is actuatedelectronically (e.g., via intelligent cuff inflation and/or based on atime interval) to obtain blood pressure information. The cuff 112 iscoupled to a wireless transceiver 116. The blood pressure device 110 ais also coupled to a fingertip optical sensor 102 via a cable 107. Theoptical sensor 102 can include one or more emitters and detectors forobtaining physiological information indicative of one or more bloodparameters of the patient 101. These parameters can include variousblood analytes such as oxygen, carbon monoxide, methemoglobin, totalhemoglobin, glucose, proteins, glucose, lipids, a percentage thereof(e.g., concentration or saturation), and the like. The optical sensor102 can also be used to obtain a photoplethysmograph, a measure ofplethysmograph variability, a measure of blood perfusion, and the like.

Additionally, the blood pressure device 110 a is coupled to an acousticsensor 104 a via a cable 105. The cable 105 connecting the acousticsensor 104 a to the blood pressure device 110 includes two portions,namely a cable 105 a and a cable 105 b. The cable 105 a connects theacoustic sensor 104 a to an anchor 104 b, which is coupled to the bloodpressure device 110 a via the cable 105 b. The anchor 104 b can beadhered to the patient's skin to reduce noise due to accidental tuggingof the acoustic sensor 104 a.

The acoustic sensor 104 a can be a piezoelectric sensor or the like thatobtains physiological information reflective of one or more respiratoryparameters of the patient 101. These parameters can include, forexample, respiratory rate, inspiratory time, expiratory time,inspiration-to-expiration ratio, inspiratory flow, expiratory flow,tidal volume, minute volume, apnea duration, breath sounds, rales,rhonchi, stridor, and changes in breath sounds such as decreased volumeor change in airflow. In addition, in some cases the respiratory sensor104 a, or another lead of the respiratory sensor 104 a (not shown), canmeasure other physiological sounds such as heart rate (e.g., to helpwith probe-off detection), heart sounds (e.g., S1, S2, S3, S4, andmurmurs), and changes in heart sounds such as normal to murmur or splitheart sounds indicating fluid overload. In some implementations, asecond acoustic respiratory sensor can be provided over the patient's101 chest for additional heart sound detection. In one embodiment, theacoustic sensor 104 can include any of the features described in U.S.Patent Application No. 61/141,584, filed Dec. 30, 2008, titled “AcousticSensor Assembly,” the disclosure of which is hereby incorporated byreference in its entirety.

The acoustic sensor 104 can also be used to generate an exciter waveformthat can be detected by the optical sensor 102 at the fingertip, by anoptical sensor attached to an ear of the patient (see FIGS. 2A, 3), byan ECG sensor (see FIG. 2C), or by another acoustic sensor (not shown).The velocity of the exciter waveform can be calculated by a processor(such as a processor in the wireless transceiver 120, described below).From this velocity, the processor can derive a blood pressuremeasurement or blood pressure estimate. The processor can output theblood pressure measurement for display. The processor can also use theblood pressure measurement to determine whether to trigger the bloodpressure cuff 112.

In another embodiment, the acoustic sensor 104 placed on the upper chestcan be advantageously combined with an ECG electrode (such as instructure 208 of FIG. 2B), thereby providing dual benefit of two signalsgenerated from a single mechanical assembly. The timing relationshipfrom fidicial markers from the ECG signal, related cardiac acousticsignal and the resulting peripheral pulse from the finger pulseoximeters produces a transit time that correlates to the cardiovascularperformance such as blood pressure, vascular tone, vascular volume andcardiac mechanical function. Pulse wave transit time or PWTT incurrently available systems depends on ECG as the sole reference point,but such systems may not be able to isolate the transit time variablesassociated to cardiac functions, such as the pre-ejection period (PEP).In certain embodiments, the addition of the cardiac acoustical signalallows isolation of the cardiac functions and provides additionalcardiac performance metrics. Timing calculations can be performed by theprocessor in the wireless transceiver 120 or a in distributed processorfound in an on-body structure (e.g., such as any of the devices hereinor below: 112, 210, 230, 402, 806).

In certain embodiments, the wireless patient monitoring system 100 usessome or all of the velocity-based blood pressure measurement techniquesdescribed in U.S. Pat. No. 5,590,649, filed Apr. 15, 1994, titled“Apparatus and Method for Measuring an Induced Perturbation to DetermineBlood Pressure,” or in U.S. Pat. No. 5,785,659, filed Jan. 17, 1996,titled “Automatically Activated Blood Pressure Measurement Device,” thedisclosures of which are hereby incorporated by reference in theirentirety. An example display related to such blood pressure calculationsis described below with respect to FIG. 7.

The wireless transceiver 116 can transmit data using any of a variety ofwireless technologies, such as Wi-Fi (802.11x), Bluetooth (802.15.2),Zigbee (802.15.4), cellular telephony, infrared, RFID, satellitetransmission, proprietary protocols, combinations of the same, and thelike. The wireless transceiver 116 can perform solely telemetryfunctions, such as measuring and reporting information about the patient101. Alternatively, the wireless transceiver 116 can be a transceiverthat also receives data and/or instructions, as will be described infurther detail below.

The wireless receiver 120 receives information from and/or sendsinformation to the wireless transceiver via an antenna (not shown). Incertain embodiments, the wireless receiver 120 is a patient monitor. Assuch, the wireless receiver 120 can include one or more processors thatprocess sensor signals received from the wireless transceiver 116corresponding to the sensors 102 a, 102 b, 104, and/or 106 in order toderive any of the physiological parameters described above. The wirelesstransceiver 120 can also display any of these parameters, includingtrends, waveforms, related alarms, and the like. The wireless receiver120 can further include a computer-readable storage medium, such as aphysical storage device, for storing the physiological data. Thewireless transceiver 120 can also include a network interface forcommunicating the physiological data to one or more hosts over anetwork, such as to a nurse's station computer in a hospital network.

Moreover, in certain embodiments, the wireless transceiver 116 can sendraw data for processing to a central nurse's station computer, to aclinician device, and/or to a bedside device (e.g., the receiver 116).The wireless transceiver 116 can also send raw data to a central nurse'sstation computer, clinician device, and/or to a bedside device forcalculation, which retransmits calculated measurements back to the bloodpressure device 110 (or to the bedside device). The wireless transceiver116 can also calculate measurements from the raw data and send themeasurements to a central nurse's station computer, to a pager or otherclinician device, or to a bedside device (e.g., the receiver 116). Manyother configurations of data transmission are possible.

In addition to deriving any of the parameters mentioned above from thedata obtained from the sensors 102 a, 102 b, 104, and/or 106, thewireless transceiver 120 can also determine various measures of dataconfidence, such as the data confidence indicators described in U.S.Pat. No. 7,024,233 entitled “Pulse oximetry data confidence indicator,”the disclosure of which is hereby incorporated by reference in itsentirety. The wireless transceiver 120 can also determine a perfusionindex, such as the perfusion index described in U.S. Pat. No. 7,292,883entitled “Physiological assessment system,” the disclosure of which ishereby incorporated by reference in its entirety. Moreover, the wirelesstransceiver 120 can determine a plethysmograph variability index (PVI),such as the PVI described in U.S. Publication No. 2008/0188760 entitled“Plethysmograph variability processor,” the disclosure of which ishereby incorporated by reference in its entirety.

In addition, the wireless transceiver 120 can send data and instructionsto the wireless transceiver 116 in some embodiments. For instance, thewireless transceiver 120 can intelligently determine when to inflate thecuff 112 and can send inflation signals to the transceiver 116.Similarly, the wireless transceiver 120 can remotely control any othersensors that can be attached to the transceiver 116 or the cuff 112. Thetransceiver 120 can send software or firmware updates to the transceiver116. Moreover, the transceiver 120 (or the transceiver 116) can adjustthe amount of signal data transmitted by the transceiver 116 based atleast in part on the acuity of the patient, using, for example, any ofthe techniques described in U.S. Patent Publication No. 2009/0119330,filed Jan. 7, 2009, titled “Systems and Methods for Storing, Analyzing,and Retrieving Medical Data,” the disclosure of which is herebyincorporated by reference in its entirety.

In alternative embodiments, the wireless transceiver 116 can performsome or all of the patient monitor functions described above, instead ofor in addition to the monitoring functions described above with respectto the wireless transceiver 120. In some cases, the wireless transceiver116 might also include a display that outputs data reflecting any of theparameters described above (see, e.g., FIG. 5). Thus, the wirelesstransceiver 116 can either send raw signal data to be processed by thewireless transceiver 120, can send processed signal data to be displayedand/or passed on by the wireless transceiver 120, or can perform somecombination of the above. Moreover, in some implementations, thewireless transceiver 116 can perform at least some front-end processingof the data, such as bandpass filtering, analog-to-digital conversion,and/or signal conditioning, prior to sending the data to the transceiver120. An alternative embodiment may include at least some front endprocessing embedded in any of the sensors described herein (such assensors 102, 104, 204, 202, 208, 412, 804, 840, 808) or cable hub 806(see FIG. 8).

In certain embodiments, the cuff 112 is a reusable, disposable, orresposable device. Similarly, any of the sensors 102, 104 a or cables105, 107 can be disposable or resposable. Resposable devices can includedevices that are partially disposable and partially reusable. Thus, forexample, the acoustic sensor 104 a can include reusable electronics buta disposable contact surface (such as an adhesive) where the sensor 104a comes into contact with the patient's skin. Generally, any of thesensors, cuffs, and cables described herein can be reusable, disposable,or resposable.

The cuff 112 can also can have its own power (e.g., via batteries)either as extra power or as a sole source of power for the transceiver116. The batteries can be disposable or reusable. In some embodiments,the cuff 112 can include one or more photovoltaic solar cells or otherpower sources. Likewise, batteries, solar sources, or other powersources can be provided for either of the sensors 102, 104 a.

Referring to FIG. 1B, another embodiment of the system 100B is shown. Inthe system 100B, the blood pressure device 110 b can communicatewirelessly with the acoustic sensor 104 a and with the optical sensor102. For instance, wireless transceivers (not shown) can be provided inone or both of the sensors 102, 104 a, using any of the wirelesstechnologies described above. The wireless transceivers can transmitdata, raw signals, processed signals, conditioned signals, or the liketo the blood pressure device 110 b. The blood pressure device 110 b cantransmit these signals on to the wireless transceiver 120. In addition,in some embodiments, the blood pressure device 110 b can also processthe signals received from the sensors 102, 104 a prior to transmittingthe signals to the wireless transceiver 120. The sensors 102, 104 a canalso transmit data, raw signals, processed signals, conditioned signals,or the like directly to the wireless transceiver 120 or patient monitor.In one embodiment, the system 100B shown can be considered to be a bodyLAN, piconet, or other individual network.

FIGS. 2A and 2B illustrate additional embodiments of patient monitoringsystems 200A and 200B, respectively. In particular, FIG. 2A illustratesa wireless patient monitoring system 200A, while FIG. 2B illustrates astandalone patient monitoring system 200B.

Referring specifically to FIG. 2A, a blood pressure device 210 a isconnected to a patient 201. The blood pressure device 210 a includes awireless transceiver 216 a, which can transmit sensor data obtained fromthe patient 201 to a wireless receiver at 220 via antenna 218. In thedepicted embodiment, the blood pressure device 210 a includes aninflatable cuff 212 a, which can include any of the features of the cuff112 described above. Additionally, the cuff 212 a includes a pocket 214,which holds the wireless transceiver 216 a (shown by dashed lines). Thewireless transceiver 216 a can be electrically connected to the cuff 212a via a connector (see, e.g., FIG. 5) in some embodiments. As will bedescribed elsewhere herein, the form of attachment of the wirelesstransceiver 216 a to the cuff 212 a is not restricted to a pocketconnection mechanism and can vary in other implementations.

The wireless transceiver 216 a is also coupled to various sensors inFIG. 2A, including an acoustic sensor 204 a and an optical ear sensor202 a. The acoustic sensor 204 a can have any of the features of theacoustic sensor 104 described above. The ear clip sensor 202 a can be anoptical sensor that obtains physiological information regarding one ormore blood parameters of the patient 201. These parameters can includeany of the blood-related parameters described above with respect to theoptical sensor 102. In one embodiment, the ear clip sensor 202 a is anLNOP TC-I ear reusable sensor available from Masimo® Corporation ofIrvine, Calif. In other embodiments, the ear clip sensor 202 a is aconcha ear sensor (see FIGS. 4A and 4B).

Advantageously, in the depicted embodiment, the sensors 202 a, 204 a arecoupled to the wireless transceiver 216 a via a single cable 205. Thecable 205 is shown having two sections, a cable 205 a and a cable 205 b.For example, the wireless transceiver 216 a is coupled to an acousticsensor 204 a via the cable 205 b. In turn, the acoustic sensor 204 a iscoupled to the optical ear sensor 202 a via the cable 205 a.Advantageously, because the sensors 202 a, 204 are attached to thewireless transceiver 216 in the cuff 212 in the depicted embodiment, thecable 205 is relatively short and can thereby increase the patient's 201freedom of movement. Moreover, because a single cable 205 is used toconnect both sensors 202 a, 204 a, the patient's mobility and comfortcan be further enhanced.

In some embodiments, the cable 205 is a shared cable 205 that is sharedby the optical ear sensor 202 a and the acoustic sensor 204 a. Theshared cable 205 can share power and ground lines for each of thesensors 202 a, 204 a. Signal lines in the cable 205 can convey signalsfrom the sensors 202 a, 204 a to the wireless transceiver 216 and/orinstructions from the wireless transceiver 216 to the sensors 202 a, 204a. The signal lines can be separate within the cable 205 for thedifferent sensors 202 a, 204 a. Alternatively, the signal lines can beshared as well, forming an electrical bus.

The two cables 205 a, 205 a can be part of a single cable or can beseparate cables 205 a, 205 b. As a single cable 205, in one embodiment,the cable 205 a, 205 b can connect to the acoustic sensor 204 a via asingle connector. As separate cables, in one embodiment, the cable 205 bcan be connected to a first port on the acoustic sensor 204 a and thecable 205 a can be coupled to a second port on the acoustic sensor 204a.

FIG. 2B further illustrates an embodiment of the cable 205 in thecontext of a standalone patient monitoring system 200B. In thestandalone patient monitoring system 200B, a blood pressure device 210 bis provided that includes a patient monitor 216 b disposed on a cuff 212b. The patient monitor 216 b includes a display 219 for outputtingphysiological parameter measurements, trends, waveforms, patient data,and optionally other data for presentation to a clinician. The display219 can be an LCD display, for example, with a touch screen or the like.The patient monitor 216 b can act as a standalone device, not needing tocommunicate with other devices to process and measure physiologicalparameters. In some embodiments, the patient monitor 216 b can alsoinclude any of the wireless functionality described above.

The patient monitor 216 b can be integrated into the cuff 212 b or canbe detachable from the cuff 212 b. In one embodiment, the patientmonitor 216 b can be a readily available mobile computing device with apatient monitoring software application. For example, the patientmonitor 216 b can be a smart phone, personal digital assistant (PDA), orother wireless device. The patient monitoring software application onthe device can perform any of a variety of functions, such ascalculating physiological parameters, displaying physiological data,documenting physiological data, and/or wirelessly transmittingphysiological data (including measurements or uncalculated raw sensordata) via email, text message (e.g., SMS or MMS), or some othercommunication medium. Moreover, any of the wireless transceivers orpatient monitors described herein can be substituted with such a mobilecomputing device.

In the depicted embodiment, the patient monitor 216 b is connected tothree different types of sensors. An optical sensor 202 b, coupled to apatient's 201 finger, is connected to the patient monitor 216 b via acable 207. In addition, an acoustic sensor 204 b and anelectrocardiograph (ECG) sensor 206 are attached to the patient monitor206 b via the cable 205. The optical sensor 202 b can perform any of theoptical sensor functions described above. Likewise, the acoustic sensor204 b can perform any of the acoustic sensor functions described above.The ECG sensor 206 can be used to monitor electrical activity of thepatient's 201 heart.

Advantageously, in the depicted embodiment, the ECG sensor 206 is abundle sensor that includes one or more ECG leads 208 in a singlepackage. For example, the ECG sensor 206 can include one, two, or threeor more leads. One or more of the leads 208 can be an active lead orleads, while another lead 208 can be a reference lead. Otherconfigurations are possible with additional leads within the samepackage or at different points on the patient's body. Using a bundle ECGsensor 206 can advantageously enable a single cable connection via thecable 205 to the cuff 212 b. Similarly, an acoustical sensor can beincluded in the ECG sensor 206 to advantageously reduce the overallcomplexity of the on-body assembly.

The cable 205 in FIG. 2B can connect two sensors to the cuff 212 b,namely the ECG sensor 206 and the acoustic sensor 204 b. Although notshown, the cable 205 can further connect an optical ear sensor to theacoustic sensor 204 b in some embodiments, optionally replacing thefinger optical sensor 202 b. The cable 205 shown in FIG. 2B can have allthe features described above with respect to FIG. 2A.

Although not shown, in some embodiments, any of the sensors, cuffs,wireless sensors, or patient monitors described herein can include oneor more accelerometers or other motion measurement devices (such asgyroscopes). For example, in FIG. 2B, one or more of the acoustic sensor204 b, the ECG sensor 206, the cuff 212 b, the patient monitor 216 b,and/or the optical sensor 202 b can include one or more motionmeasurement devices. A motion measurement device can be used by aprocessor (such as in the patient monitor 216 b or other device) todetermine motion and/or position of a patient. For example, a motionmeasurement device can be used to determine whether a patient is sittingup, lying down, walking, or the like.

Movement and/or position data obtained from a motion measurement devicecan be used to adjust a parameter calculation algorithm to compensatefor the patient's motion. For example, a parameter measurement algorithmthat compensates for motion can more aggressively compensate for motionin response to high degree of measured movement. When less motion isdetected, the algorithm can compensate less aggressively. Movementand/or position data can also be used as a contributing factor toadjusting parameter measurements. Blood pressure, for instance, canchange during patient motion due to changes in blood flow. If thepatient is detected to be moving, the patient's calculated bloodpressure (or other parameter) can therefore be adjusted differently thanwhen the patient is detected to be sitting.

A database can be assembled that includes movement and parameter data(raw or measured parameters) for one or more patients over time. Thedatabase can be analyzed by a processor to detect trends that can beused to perform parameter calculation adjustments based on motion orposition. Many other variations and uses of the motion and/or positiondata are possible.

Although the patient monitoring systems described herein, including thesystems 100A, 100B, 200A, and 200B have been described in the context ofblood pressure cuffs, blood pressure need not be measured in someembodiments. For example, the cuff can be a holder for the patientmonitoring devices and/or wireless transceivers and not include anyblood pressure measuring functionality. Further, the patient monitoringdevices and/or wireless transceivers shown need not be coupled to thepatient via a cuff, but can be coupled to the patient at any otherlocation, including not at all. For example, the devices can be coupledto the patient's belt (see FIGS. 3A and 3B), can be carried by thepatient (e.g., via a shoulder strap or handle), or can be placed on thepatient's bed next to the patient, among other possible locations.

Additionally, various features shown in FIGS. 2A and 2B can be changedor omitted. For instance, the wireless transceiver 216 can be attachedto the cuff 212 without the use of the pocket 214. For example, thewireless transceiver can be sown, glued, buttoned or otherwise attachedto the cuff using any various known attachment mechanisms. Or, thewireless transceiver 216 can be directly coupled to the patient (e.g.,via an armband) and the cuff 212 can be omitted entirely. Instead of acuff, the wireless transceiver 216 can be coupled to a non-occlusiveblood pressure device. Many other configurations are possible.

FIGS. 3A and 3B illustrate further embodiments of a patient monitoringsystem 300A, 300B having a single cable connecting multiple sensors.FIG. 3A depicts a tethered patient monitoring system 300A, while FIG. 3Bdepicts a wireless patient monitoring system 300B. The patientmonitoring systems 300A, 300B illustrate example embodiments where asingle cable 305 can be used to connect multiple sensors, without usinga blood pressure cuff.

Referring to FIG. 3A, the acoustic and ECG sensors 204 b, 206 of FIG. 2are again shown coupled to the patient 201. As above, these sensors 204b, 206 are coupled together via a cable 205. However, the cable 250 iscoupled to a junction device 230 a instead of to a blood pressure cuff.In addition, the optical sensor 202 b is coupled to the patient 201 andto the junction device 230 a via a cable 207. The junction device 230 acan anchor the cable 205 b to the patient 201 (such as via the patient'sbelt) and pass through any signals received from the sensors 202 b, 204b, 206 to a patient monitor 240 via a single cable 232.

In some embodiments, however, the junction device 230 a can include atleast some front-end signal processing circuitry. In other embodiments,the junction device 230 a also includes a processor for processingphysiological parameter measurements. Further, the junction device 230 acan include all the features of the patient monitor 216 b in someembodiments, such as providing a display that outputs parametersmeasured from data obtained by the sensors 202 b, 204 b, 206.

In the depicted embodiment, the patient monitor 240 is connected to amedical stand 250. The patient monitor 240 includes parameter measuringmodules 242, one of which is connected to the junction device 230 a viathe cable 232. The patient monitor 240 further includes a display 246.The display 246 is a user-rotatable display in the depicted embodiment.

Referring to FIG. 3B, the patient monitoring system 300B includes nearlyidentical features to the patient monitoring system 300A. However, thejunction device 230 b includes wireless capability, enabling thejunction device 230 b to wirelessly communicate with the patient monitor240 and/or other devices.

FIGS. 4A and 4B illustrate embodiments of patient monitoring systems400A, 400B that depict alternative cable connection systems 410 forconnecting sensors to a patient monitor 402. Like the cable 205described above, these cable connection systems 410 can advantageouslyenhance patient mobility and comfort.

Referring to FIG. 4A, the patient monitoring system 400A includes apatient monitor 402 a that measures physiological parameters based onsignals obtained from sensors 412, 420 coupled to a patient. Thesesensors include an optical ear sensor 412 and an acoustic sensor 420 inthe embodiment shown. The optical ear sensor 412 can include any of thefeatures of the optical sensors described above. Likewise, the acousticsensor 420 can include any of the features of the acoustic sensorsdescribed above.

The optical ear sensor 412 can be shaped to conform to the cartilaginousstructures of the ear, such that the cartilaginous structures canprovide additional support to the sensor 412, providing a more secureconnection. This connection can be particularly beneficial formonitoring during pre-hospital and emergency use where the patient canmove or be moved. In some embodiments, the optical ear sensor 412 canhave any of the features described in U.S. application Ser. No.12/658,872, filed Feb. 16, 2010, entitled “Ear Sensor,” the disclosureof which is hereby incorporated by reference in its entirety.

An instrument cable 450 connects the patient monitor 402 a to the cableconnection system 410. The cable connection system 410 includes a sensorcable 440 connected to the instrument cable 250. The sensor cable 440 isbifurcated into two cable sections 416, 422, which connect to theindividual sensors 412, 420 respectively. An anchor 430 a connects thesensor cable 440 and cable sections 416, 422. The anchor 430 a caninclude an adhesive for anchoring the cable connection system 410 to thepatient, so as to reduce noise from cable movement or the like.Advantageously, the cable connection system 410 can reduce the numberand size of cables connecting the patient to a patient monitor 402 a.The cable connection system 410 can also be used to connect with any ofthe other sensors, patient-worn monitors, or wireless devices describedabove.

FIG. 4B illustrates the patient monitoring system 400B, which includesmany of the features of the monitoring system 400A. For example, anoptical ear sensor 412 and an acoustic sensor 420 are coupled to thepatient. Likewise, the cable connection system 410 is shown, includingthe cable sections 416, 422 coupled to an anchor 430 b. In the depictedembodiment, the cable connection system 410 communicates wirelessly witha patient monitor 402 b. For example, the anchor 430 b can include awireless transceiver, or a separate wireless dongle or other device (notshown) can couple to the anchor 430 b. The anchor 430 b can be connectedto a blood pressure cuff, wireless transceiver, junction device, orother device in some embodiments.

FIG. 5 illustrates a more detailed embodiment of a wireless transceiver516. The wireless transceiver 516 can have all of the features of thewireless transceiver 516 described above. For example, the wirelesstransceiver 516 can connect to a blood pressure cuff and to one or morephysiological sensors, and the transceiver 516 can transmit sensor datato a wireless receiver.

The depicted embodiment of the transceiver 516 includes a housing 530,which includes connectors 552 for sensor cables (e.g., for optical,acoustic, ECG, and/or other sensors) and a connector 560 for attachmentto a blood pressure cuff or other patient-wearable device. Thetransceiver 516 further includes an antenna 518, which although shown asan external antenna, can be internal in some implementations.

In addition, the transceiver 516 includes a display 554 that depictsvalues of various parameters, such as systolic and diastolic bloodpressure, SpO₂, and respiratory rate (RR). The display 554 can alsodisplay trends, alarms, and the like. The transceiver 516 can beimplemented with the display 554 in embodiments where the transceiver516 also acts as a patient monitor. The transceiver 516 further includescontrols 556, which can be used to manipulate settings and functions ofthe transceiver 516.

FIGS. 6A through 6C illustrate embodiments of wireless patientmonitoring systems 600. FIG. 6A illustrates a patient monitoring system600A that includes a wireless transceiver 616, which can include thefeatures of any of the transceivers 216, 216 described above. Thetransceiver 616 provides a wireless signal over a wireless link 612 to apatient monitor 620. The wireless signal can include physiologicalinformation obtained from one or more sensors, physiological informationthat has been front-end processed by the transceiver 616, or the like.

The patient monitor 620 can act as the wireless receiver 220 of FIG. 2.The patient monitor 620 can process the wireless signal received fromthe transceiver 616 to obtain values, waveforms, and the like for one ormore physiological parameters. The patient monitor 620 can perform anyof the patient monitoring functions described above with respect toFIGS. 2 through 5.

In addition, the patient monitor 620 can provide at least some of thephysiological information received from the transceiver 616 to amulti-patient monitoring system (MMS) 640 over a network 630. The MMS640 can include one or more physical computing devices, such as servers,having hardware and/or software for providing the physiologicalinformation to other devices in the network 630. For example, the MMS640 can use standardized protocols (such as TCP/IP) or proprietaryprotocols to communicate the physiological information to one or morenurses' station computers (not shown) and/or clinician devices (notshown) via the network 630. In one embodiment, the MMS 640 can includesome or all the features of the MMS described in U.S. Publication No.2008/0188760, referred to above.

The network 630 can be a LAN or WAN, wireless LAN (“WLAN”), or othertype of network used in any hospital, nursing home, patient care center,or other clinical location. In some implementations, the network 210 caninterconnect devices from multiple hospitals or clinical locations,which can be remote from one another, through the Internet, one or moreIntranets, a leased line, or the like. Thus, the MMS 640 canadvantageously distribute the physiological information to a variety ofdevices that are geographically co-located or geographically separated.

FIG. 6B illustrates another embodiment of a patient monitoring system600B, where the transceiver 616 transmits physiological information to abase station 624 via the wireless link 612. In this embodiment, thetransceiver 616 can perform the functions of a patient monitor, such asany of the patient monitor functions described above. The transceiver616 can provide processed sensor signals to the base station 624, whichforwards the information on to the MMS 640 over the network 630.

FIG. 6C illustrates yet another embodiment of a patient monitoringsystem 600B, where the transceiver 616 transmits physiologicalinformation directly to the MMS 640. The MMS 640 can include wirelessreceiver functionality, for example. Thus, the embodiments shown inFIGS. 6A through 6C illustrate that the transceiver 616 can communicatewith a variety of different types of devices.

FIG. 7 illustrates an embodiment of a physiological parameter display700. The physiological parameter display 700 can be output by any of thesystems described above. For instance, the physiological parameterdisplay 700 can be output by any of the wireless receivers,transceivers, or patient monitors described above. Advantageously, incertain embodiments, the physiological parameter display 700 can displaymultiple parameters, including noninvasive blood pressure (NIBP)obtained using both oscillometric and non-oscillometric techniques.

The physiological parameter display 700 can display any of thephysiological parameters described above, to name a few. In the depictedembodiment, the physiological parameter display 700 is shown displayingoxygen saturation 702, heart rate 704, and respiratory rate 706. Inaddition, the physiological parameter display 700 displays bloodpressure 708, including systolic and diastolic blood pressure.

The display 700 further shows a plot 710 of continuous or substantiallycontinuous blood pressure values measured over time. The plot 710includes a trace 712 a for systolic pressure and a trace 712 b fordiastolic pressure. The traces 712 a, 712 b can be generated using avariety of devices and techniques. For instance, the traces 712 a, 712 bcan be generated using any of the velocity-based continuous bloodpressure measurement techniques described above and described in furtherdetail in U.S. Pat. Nos. 5,590,649 and 5,785,659, referred to above.

Periodically, oscillometric blood pressure measurements (sometimesreferred to as Gold Standard NIBP) can be taken, using any of the cuffsdescribed above. These measurements are shown by markers 714 on the plot710. By way of illustration, the markers 714 are “X's” in the depictedembodiment, but the type of marker 714 used can be different in otherimplementations. In certain embodiments, oscillometric blood pressuremeasurements are taken at predefined intervals, resulting in themeasurements shown by the markers 714.

In addition to or instead of taking these measurements at intervals,oscillometric blood pressure measurements can be triggered using ICItechniques, e.g., based at least partly on an analysis of thenoninvasive blood pressure measurements indicated by the traces 712 a,712 b. Advantageously, by showing both types of noninvasive bloodpressure measurements in the plot 710, the display 700 can provide aclinician with continuous and oscillometric blood pressure information.

FIG. 8 illustrates another embodiment of a patient monitoring system800. The features of the patient monitoring system 800 can be combinedwith any of the features of the systems described above. Likewise, anyof the features described above can be incorporated into the patientmonitoring system 800. Advantageously, in the depicted embodiment, thepatient monitoring system 800 includes a cable hub 806 that enables oneor many sensors to be selectively connected and disconnected to thecable hub 806.

Like the patient monitoring systems described above, the monitoringsystem 800 includes a cuff 810 with a patient device 816 for providingphysiological information to a monitor 820 or which can receive powerfrom a power supply (820). The cuff 810 can be a blood pressure cuff ormerely a holder for the patient device 816. The patient device 816 caninstead be a wireless transceiver having all the features of thewireless devices described above.

The patient device 816 is in coupled with an optical finger sensor 802via cable 807. Further, the patient device 816 is coupled with the cablehub 806 via a cable 805 a. The cable hub 806 can be selectivelyconnected to one or more sensors. In the depicted embodiment, examplesensors shown coupled to the cable hub 806 include an ECG sensor 808 aand a brain sensor 840. The ECG sensor 808 a can be single-lead ormulti-lead sensor. The brain sensor 840 can be an electroencephalography(EEG) sensor and/or an optical sensor. An example of EEG sensor that canbe used as the brain sensor 840 is the SEDLine™ sensor available fromMasimo® Corporation of Irvine, Calif., which can be used fordepth-of-anesthesia monitoring among other uses. Optical brain sensorscan perform spectrophotometric measurements using, for example,reflectance pulse oximetry. The brain sensor 840 can incorporate both anEEG/depth-of-anesthesia sensor and an optical sensor for cerebraloximetry.

The ECG sensor 808 a is coupled to an acoustic sensor 804 and one ormore additional ECG leads 808 b. For illustrative purposes, fouradditional leads 808 b are shown, for a 5-lead ECG configuration. Inother embodiments, one or two additional leads 808 b are used instead offour additional leads. In still other embodiments, up to at least 12leads 808 b can be included. Acoustic sensors can also be disposed inthe ECG sensor 808 a and/or lead(s) 808 b or on other locations of thebody, such as over a patient's stomach (e.g., to detect bowel sounds,thereby verifying patient's digestive health, for example, inpreparation for discharge from a hospital). Further, in otherembodiments, the acoustic sensor 804 can connect directly to the cablehub 806 instead of to the ECG sensor 808 a.

As mentioned above, the cable hub 806 can enable one or many sensors tobe selectively connected and disconnected to the cable hub 806. Thisconfigurability aspect of the cable hub 806 can allow different sensorsto be attached or removed from a patient based on the patient'smonitoring needs, without coupling new cables to the monitor 820.Instead, a single, light-weight cable 832 couples to the monitor 820 incertain embodiments, or wireless technology can be used to communicatewith the monitor 820 (see, e.g., FIG. 1). A patient's monitoring needscan change as the patient is moved from one area of a care facility toanother, such as from an operating room or intensive care unit to ageneral floor. The cable configuration shown, including the cable hub806, can allow the patient to be disconnected from a single cable to themonitor 820 and easily moved to another room, where a new monitor can becoupled to the patient. Of course, the monitor 820 may move with thepatient from room to room, but the single cable connection 832 ratherthan several can facilitate easier patient transport.

Further, in other embodiments, the cuff 810 and/or patient device 816need not be included, but the cable hub 806 can instead connect directlyto the monitor wirelessly or via a cable. Additionally, the cable hub806 or the patient device 816 may include electronics for front-endprocessing, digitizing, or signal processing for one or more sensors.Placing front-end signal conditioning and/or analog-to-digitalconversion circuitry in one or more of these devices can make itpossible to send continuous waveforms wirelessly and/or allow for asmall, more user-friendly wire (and hence cable 832) routing to themonitor 820.

The cable hub 806 can also be attached to the patient via an adhesive,allowing the cable hub 806 to become a wearable component. Together, thevarious sensors, cables, and cable hub 806 shown can be a completebody-worn patient monitoring system. The body-worn patient monitoringsystem can communicate with a patient monitor 820 as shown, which can bea tablet, handheld device, a hardware module, or a traditional monitorwith a large display, to name a few possible devices.

Depending on the embodiment, certain acts, events, or functions of anyof the methods described herein can be performed in a differentsequence, can be added, merged, or left out all together (e.g., not alldescribed acts or events are necessary for the practice of the method).Moreover, in certain embodiments, acts or events can be performedconcurrently, e.g., through multi-threaded processing, interruptprocessing, or multiple processors, rather than sequentially.

The various illustrative logical blocks, modules, circuits, andalgorithm steps described in connection with the embodiments disclosedherein can be implemented as electronic hardware, computer software, orcombinations of both. To clearly illustrate this interchangeability ofhardware and software, various illustrative components, blocks, modules,circuits, and steps have been described above generally in terms oftheir functionality. Whether such functionality is implemented ashardware or software depends upon the particular application and designconstraints imposed on the overall system. The described functionalitycan be implemented in varying ways for each particular application, butsuch implementation decisions should not be interpreted as causing adeparture from the scope of the disclosure.

The various illustrative logical blocks, modules, and circuits describedin connection with the embodiments disclosed herein can be implementedor performed with a general purpose processor, a digital signalprocessor (DSP), an application specific integrated circuit (ASIC), afield programmable gate array (FPGA) or other programmable logic device,discrete gate or transistor logic, discrete hardware components, or anycombination thereof designed to perform the functions described herein.A general purpose processor can be a microprocessor, but in thealternative, the processor can be any conventional processor,controller, microcontroller, or state machine. A processor can also beimplemented as a combination of computing devices, e.g., a combinationof a DSP and a microprocessor, a plurality of microprocessors, one ormore microprocessors in conjunction with a DSP core, or any other suchconfiguration.

The steps of a method or algorithm described in connection with theembodiments disclosed herein can be embodied directly in hardware, in asoftware module executed by a processor, or in a combination of the two.A software module can reside in RAM memory, flash memory, ROM memory,EPROM memory, EEPROM memory, registers, hard disk, a removable disk, aCD-ROM, or any other form of storage medium known in the art. Anexemplary storage medium is coupled to the processor such the processorcan read information from, and write information to, the storage medium.In the alternative, the storage medium can be integral to the processor.The processor and the storage medium can reside in an ASIC. The ASIC canreside in a user terminal. In the alternative, the processor and thestorage medium can reside as discrete components in a user terminal.

Conditional language used herein, such as, among others, “can,” “may,”“might,” “could,” “e.g.,” and the like, unless specifically statedotherwise, or otherwise understood within the context as used, isgenerally intended to convey that certain embodiments include, whileother embodiments do not include, certain features, elements and/orsteps. Thus, such conditional language is not generally intended toimply that features, elements and/or steps are in any way required forone or more embodiments or that one or more embodiments necessarilyinclude logic for deciding, with or without author input or prompting,whether these features, elements and/or steps are included or are to beperformed in any particular embodiment.

While the above detailed description has shown, described, and pointedout novel features as applied to various embodiments, it will beunderstood that various omissions, substitutions, and changes in theform and details of the device or process illustrated can be madewithout departing from the spirit of the disclosure. As will berecognized, certain embodiments of the inventions described herein canbe embodied within a form that does not provide all of the features andbenefits set forth herein, as some features can be used or practicedseparately from others. The scope of the inventions is indicated by theappended claims rather than by the foregoing description. All changeswhich come within the meaning and range of equivalency of the claims areto be embraced within their scope.

1. A patient monitoring system, the system comprising: a first sensorconfigured to be coupled with a patient and to obtain firstphysiological information from the patient, the first physiologicalinformation reflecting a first physiological parameter of the patient; asecond sensor configured to be coupled with the patient, the secondsensor being a different type of sensor than the first sensor, thesecond sensor further configured to obtain second physiologicalinformation from the patient, the second physiological informationreflecting a second physiological parameter of the patient; a cable hubconfigured to electrically couple the first and second sensors with ablood pressure cuff, the blood pressure cuff comprising a processorconfigured to receive the first and second physiological informationfrom the first and second sensors; and the cable hub configured toselectively couple one or more additional physiological sensors with theblood pressure cuff.
 2. The patient monitoring system of claim 1,wherein the one or more additional physiological sensors comprises abrain sensor.
 3. The patient monitoring system of claim 2, wherein thebrain sensor comprises one or more of the following: an optical sensorand an electroencephalography (EEG) sensor.
 4. The patient monitoringsystem of claim 1, wherein the first sensor comprises anelectrocardiograph (ECG) sensor.
 5. The patient monitoring system ofclaim 1, wherein the first sensor comprises an acoustic sensor.
 6. Thepatient monitoring system of claim 1, wherein the first sensor is an earoptical sensor and the second sensor is an acoustic respiratory sensor.7. A patient monitoring device comprising: a cable assembly configuredto be coupled with a plurality of physiological sensors, the cableassembly comprising: a cable hub coupled with the first cable section,the cable hub configured to selectively couple with one or more of theplurality of physiological sensors operative to obtain physiologicalinformation from the patient, and a cable configured to couple to thecable hub and to a patient-worn device, the patient-worn deviceconfigured to communicate the physiological information to aphysiological monitor.
 8. The patient monitoring device of claim 7,wherein the cable hub is configured to enable the physiological sensorsto be selectively connected and disconnected in response to differentmonitoring needs for the patient.
 9. The patient monitoring device ofclaim 7, wherein the patient-worn device is connected to thephysiological monitor with a single monitor cable.
 10. The patientmonitoring device of claim 7, wherein the patient-worn device is awireless device configured to communicate the physiological informationto the physiological monitor.
 11. The patient monitoring device of claim10, wherein the wireless device is configured to be coupled with a bloodpressure cuff.
 12. The patient monitoring device of claim 7, wherein thecable hub is configured to couple with one or more of the followingphysiological sensors: an electrocardiograph (ECG) sensor, an acousticsensor, an optical sensor, and an electroencephalography (EEG) sensor.13. A patient monitoring system, the system comprising: a first sensorconfigured to be coupled with a patient and to obtain firstphysiological information from the patient, the first physiologicalinformation reflecting a first physiological parameter of the patient; asecond sensor configured to be coupled with the patient, the secondsensor being a different type of sensor than the first sensor, thesecond sensor further configured to obtain second physiologicalinformation from the patient, the second physiological informationreflecting a second physiological parameter of the patient; and a cablehub configured to electrically couple with the first and second sensorsand to provide the first and second physiological information to apatient-worn device.
 14. The patient monitoring system of claim 13,wherein the patient-worn device comprises a wireless device configuredto provide the first and second physiological information to aphysiological monitor.
 15. The patient monitoring system of claim 13,wherein the patient-worn device is configured to be coupled with amonitor cable that connects to the physiological monitor.
 16. Thepatient monitoring system of claim 13, wherein patient-worn devicecomprises a blood pressure cuff.
 17. The patient monitoring system ofclaim 16, wherein the blood pressure cuff comprises a wireless deviceconfigured to provide the first and second physiological information toa physiological monitor.
 18. The patient monitoring system of claim 16,wherein the blood pressure cuff is configured to couple to a monitorcable that connects to the physiological monitor.